Diagnosis

The mainstay for screening of all women is a breast examination by an experienced clinician, screening mammogram, ultrasound, and breast Magnetic Resonance Imaging (MRI) for high risk women.

A breast lump has been found by me or my doctor.

When this occurs it is important to have an exam by a breast specialist right away. For women over 30 years old a diagnostic mammogram will be performed and all women will get a breast ultrasound.

An abnormality is seen on my ultrasound.

Sometimes normal appearing prominent breast tissue will be found, or a benign simple cyst, or mass/cyst that hasn’t changed for awhile. Often this will just require a follow-up examination in 3-6 months.

If a new cluster of cysts or a complex cyst is found, your doctor may recommend a cyst aspiration and/or a follow-up ultrasound in 6 month. A complex cyst is a cyst where it is difficult to tell if there is a solid component within the cyst. A cyst aspiration is when the doctor places a skinny needle into the cyst and removes the fluid. Depending upon how the fluid looks, it may be sent for examination by the pathologist.

When a solid mass is discovered that has not been there before or has changed since last exam, it is important to get a biopsy to make sure it is not malignant. This can be performed as an outpatient under local anesthesia.

An abnormality is seen on my mammogram.

When an abnormality is seen on a screening mammography, additional views will need to be obtained. If they find a focus of micro-calcifications, they will do magnification views to get a better look at the type of calcifications. If they find a mass or asymmetric thickening they will do compression views, attempting to flattened the tissue to see if there is really a worrisome lesion there or not. If a new abnormality is found on mammogram either a biopsy or a 6-month follow-up will be recommended.

If a biopsy is recommended and the abnormality is not seen on ultrasound, your doctor may order a stereotactic core biopsy.

I have an abnormality found on screening breast MRI.

When an abnormality is found on screening breast MRI a patient may need to get a further ultrasound studies. If it appears benign on ultrasound, a repeat MRI may be scheduled for 6 month follow-up. If it appears worrisome or if it can’t be seen on ultrasound, generally a biopsy is warranted.

I need a breast biopsy.

Breast biopsies are performed for suspicious abnormalities, abnormalities that are neither clearly worrisome nor benign, or newly discovered abnormalities. Despite the advances in technology, most women whom undergo breast biopsy have benign diagnoses. All abnormalities that need to be biopsied should be considered for needle core biopsy. In this procedure, the breast is numbed with local anesthesia. The doctor makes a small nick in the skin and places a biopsy needle into the lump. The device takes out several small cores of tissue for examination for diagnosis by the pathologist. In addition, a small inert metallic clip is placed into the area so that the doctors will know where in the breast the biopsy was taken from, and, if it needs to be surgically removed, the doctors will know where to remove more tissue.

If the area to be biopsied can only be seen by ultrasound then the doctor has to use the ultrasound to guide the biopsy needle. This is called ultrasound guided core biopsy. Click here for more information.

If the area to be biopsied can only be seen by mammography then the doctor has to use the mammogram to guide the biopsy needle. This is called stereotactic core biopsy. Click here for more information.

If the area to be biopsied can only be seen by MRI then the doctor has to use the MRI to guide the biopsy needle. This is called MRI-guided core biopsy.  Click here for more information.

Instructions for after a breast core biopsy [PDF]

 

My breast biopsy can’t be performed by needle core.

There are many reasons why some women can’t have a needle core biopsy. Sometimes it’s related to where the lesion is situated within the breast, making it inaccessible to the needle technology. Sometimes the women’s anatomy or breast size is prohibitive. Other times it is just too difficult for some patients to tolerate the positions or calmness required for a breast core biopsy.

In these circumstances then the breast biopsy needs to be performed surgically. If the area to be biopsy can be felt than the biopsy can simply be performed as an outpatient under local anesthesia with intravenous sedation.  If the biopsy area is seen only by ultrasound, mammography, or MRI than the radiologist needs to first find the area using the relevant test. Under local anesthesia a skinny needle and/or wire is placed next to the area to be biopsied using the ultrasound, mammogram, or MRI to guide them.. The needle is kept in and the patient is brought to the operating room for the biopsy. Under local anesthesia with intravenous sedation, a minimal incision is made near the site to be biopsy in an area that is most cosmetically pleasing. The lesion is than surgically removed and assessed using palpation, ultrasound, or x-ray to make sure the lesion is removed. The incision is then closed with plastic surgery techniques with dis solvable sutures under the skin.

Instructions after a surgical breast biopsy [PDF]

This information does not replace expert evaluation and advice from a trained breast care professional. If you have noted any breast problems please seek care from a breast surgeon as soon as possible.